Suture passing surgical instrument

ABSTRACT

A surgical instrument includes first and second members configured to receive tissue therebetween. The first member is adapted to receive suture, the second member is coupled to the first member, and a grasper coupled to the second member engages the suture received by the first member. A method of passing suture includes loading suture into a first member of a suture passing surgical instrument, stabilizing tissue between the first member and a second member of the surgical instrument, passing suture through tissue via the first member of the surgical instrument, holding the passed suture via a suture grasper of the surgical instrument, and removing the first member from the tissue.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation (and claims the benefit of priorityunder 35 USC 120) of U.S. application Ser. No. 10/151,812, filed May 22,2002. The disclosure of the prior application is considered part of (andis incorporated by reference in) the disclosure of this application.

TECHNICAL FIELD

This invention relates to suture passing surgical instruments, and moreparticularly, to a surgical instrument and method for single-handedlypassing suture through tissue.

BACKGROUND

Suture is passed through tissue many ways including, for example,cannulated needles and instruments and needle passing instruments, whichin general, require the use of multiple portal entry points in order totransfer the suture through tissue or require the use of additionalinstruments or devices to facilitate the passage of suture. As describedin U.S. Pat. No. 5,935,149, it is known to place the suture at a desiredsite to be sutured by passing a needle attached to the suture from afirst member of a suture passing forceps to a second member of theforceps. The suture is secured at the site by passing the needle througha suture receiving passage in an outer member of a suture securingdevice to position a portion of the suture therein and inserting aninner member of the suture securing device into the passage to securethe portion of the suture between the inner and outer members. Theneedle is passed through the passage by threading the needle through asuture threader disposed in the passage and pulling the threader fromthe passage. The suture threader has one end terminating in the needledsuture and an opposite end terminating in a suture receiving loop.

SUMMARY

In one general aspect of the invention, a surgical instrument includesfirst and second members configured to receive tissue therebetween. Thefirst member is adapted to receive suture, the second member is coupledto the first member, and a grasper is coupled to the second member forengaging the suture received by the first member.

Embodiments of this aspect of the invention may include one or more ofthe following features. The grasper is coupled to the second member formovement between a retracted position and a suture engaging position.The second member defines a slot for receiving suture from the firstmember, and the grasper is configured to trap suture within the slot.The first member is configured to move relative to the second memberbetween an open position and a closed, tissue piercing position. Thesecond member defines a passageway for receiving a portion of the firstmember. The second member defines a slot for receiving suture from thefirst member. The slot opens into the passageway.

The first member includes a needle for piercing tissue. The needledefines an eyelet for receiving suture. The eyelet includes a hole.Alternatively, the eyelet includes two holes. In another alternative,the eyelet includes a cutout.

The surgical instrument also includes a handle that controls movement ofthe first member. The handle includes an articulating handle and astationary handle.

The second member includes a passageway that receives a portion of thefirst member. The second member includes at least one suture slot thatis disposed in a lengthwise side of the passageway. Also, the at leastone suture slot opens to the passageway.

The first member includes a jaw and a needle arm extending from a distalend of the surgical instrument. The needle arm is adapted to receivesuture. The jaw defines a passageway that receives a portion of theneedle arm. The second member defines a passageway that receives asecond portion of the needle arm. The second member defines at least onesuture slot that is disposed in a lengthwise side of the passageway andopens to the passageway. The suture grasper engages the suture and holdsthe suture in the at least one suture slot.

The grasper is disposed on a portion of the second member. The grasperincludes a hook. Alternatively, the grasper includes a wedge. In anotheralternative, the grasper includes a set of jaws. In another alternative,the grasper includes a U-shaped cup.

The surgical instrument includes a trigger that controls the grasper.The trigger is a paddle. Alternatively, the trigger is a lever. Inanother alternative, the trigger is a button. The surgical instrumentalso includes a grasper guide that is disposed on a portion of thesecond member. The trigger moves the grasper distally under the grasperguide to engage the suture.

A portion of the first member is serrated. A portion of the secondmember is serrated.

In another general aspect of the invention, a method of passing sutureincludes loading suture into a first member of a suture passing surgicalinstrument, stabilizing tissue between the first member and a secondmember of the surgical instrument, passing suture through tissue via thefirst member of the surgical instrument, holding the passed suture via asuture grasper of the surgical instrument, and removing the first memberfrom the tissue.

Embodiments of this aspect of the invention may include one or more ofthe following features. After loading suture, the surgical instrument ispassed through a cannula. The method also includes removing the surgicalinstrument from the surgical site.

Loading suture includes loading suture from a side of the surgicalinstrument. Loading suture further includes loading suture from the sideof the surgical instrument on which the suture grasper is located.

The method includes stabilizing tissue and passing suture through tissuesimultaneously.

The method includes passing suture multiple times. Passing suturemultiple times includes loading suture into the first member of thesuture passing surgical instrument, and passing suture through tissuevia the first member of the suture passing instrument.

Conventional instruments and methods for passing suture generallyrequire multiple portal entry points and/or supplemental instruments tofacilitate passage of suture. The surgical instrument of this inventionovercomes these difficulties. In particular, the instrument and methodprovide a surgeon with the ability to single-handedly pass suturethrough tissue. As a result, only one portal and one instrument arerequired.

The details of one or more implementations are set forth in theaccompanying drawings and the description below. Other features andobjects will be apparent from the description and drawings, and from theclaims.

DESCRIPTION OF DRAWINGS

FIG. 1 is a partial cross-sectional view of an exemplary suture passingsurgical instrument.

FIG. 2 is a partial cross-sectional view of a distal portion of thesurgical instrument of FIG. 1 in which an articulating jaw is closed.

FIG. 3A is a side view and FIG. 3B is a perspective view of a push/pullrod for the articulating jaw of the surgical instrument of FIG. 1.

FIG. 3C is a top view of an elongated shaft of the surgical instrumentof FIG. 1.

FIG. 3D is a partial cross-sectional view of a proximal portion of thesurgical instrument of FIG. 1.

FIG. 4A is a top view of a distal portion of the surgical instrument ofFIG. 1 showing a suture grasper capturing the suture and FIG. 4B is aperspective view of the distal portion of the surgical instrument ofFIG. 1 showing the eyelet of the needle in line with the suture slots ofthe passageway.

FIG. 5A is an exemplary tip of a suture capture device of the suturegrasper and FIG. 5B is an exemplary arm of the suture capture device ofthe suture grasper of the surgical instrument of FIG. 1.

FIG. 6A is a partial cutaway top view of a trigger portion for thesuture grasper shown in an open position and FIG. 6B is a partialcutaway top view of the trigger portion for the suture grasper shown ina closed position.

FIGS. 7A-7H illustrate use of the surgical instrument of FIG. 1.

FIGS. 8A-8H illustrate alternative configurations of a suture eyelet ofa needle of the surgical instrument of FIG. 1.

FIG. 9 shows a suture threaded through the suture eyelet of the needleof the surgical instrument of FIG. 1.

FIG. 10 shows a suture attached to an exemplary soft tissue attachmentdevice.

FIG. 11 is a detailed side view of an articulating jaw of the surgicalinstrument of FIG. 1 showing serrations.

FIG. 12 is a detailed side view of a tissue platform of the surgicalinstrument of FIG. 1 showing serrations.

FIG. 13A is a side view of an alternate implementation of the suturegrasper.

FIG. 13B is a detailed view of the suture capture device of the suturegrasper of FIG. 13A.

FIG. 13C is a top view of an alternate implementation of the tissueplatform provided with the suture grasper of FIG. 13A.

FIGS. 14A-14H are top views of alternative implementations of the suturecapture device of the suture grasper.

FIG. 15A is a side view of the alternative implementation of thetrigger.

FIG. 15B is an exploded view of the trigger and a locking mechanism ofFIG. 15A.

FIG. 15C is a side view of another alternative implementation of thetrigger.

FIG. 15D is a detailed view of a locking mechanism of the trigger ofFIG. 15C.

FIGS. 16A-16E are top views of alternative implementations of push/pullrods of the suture grasper.

FIG. 17A is a side view of an alternate implementation of the suturepassing surgical instrument.

FIG. 17B is a perspective view of the push-pull rod of thecross-sectional view of a proximal portion of the surgical instrument ofFIG. 17A.

FIG. 17C is a detailed cross-sectional view of a proximal portion of thesurgical instrument of FIG. 17A.

FIG. 17D is a perspective view of a needle arm of the surgicalinstrument of FIG. 17A.

FIG. 17E is a partial cross-sectional view of a distal portion of thesurgical instrument of FIG. 17A.

FIG. 17F is a perspective view of a first jaw of the surgical instrumentof FIG. 17A.

FIG. 17G is a perspective view of a second jaw of the surgicalinstrument of FIG. 17A.

FIG. 17H is a perspective view of the suture grasper push rod of thesurgical instrument of FIG. 17A.

FIGS. 18A-18E illustrate use of the surgical instrument of FIG. 17.

Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION

Referring to FIG. 1, a single-handed suture passing surgical instrument100 passes suture 101 through tissue and holds the passed suture suchthat the instrument can be rethreaded to pass suture through tissuemultiple times. An operator actuates a handle 190 to close anarticulating jaw 110 through which suture is threaded to pass the suturethrough tissue, and thereafter actuates a trigger portion 150 to advancea suture grasper 130 along a tissue platform 120 to engage the suturewith the suture grasper 130. The jaw 110 is then opened and theinstrument 100 removed with the suture remaining in the tissue and heldby the suture grasper 130. The instrument 100 can be rethreaded andreinserted to the surgical site to pass suture multiple times, forinstance, as with a Mason-Allen Stitch.

Suture passing surgical instrument 100 includes an elongated shaft 140with a distal portion 105 and a proximal portion 145. Located at theproximal portion 145 of the elongated shaft 140 are handle 190 andtrigger portion 150. Located at the distal end 105 are articulating jaw110, tissue platform 120, and suture grasper 130.

The articulating jaw 110 is pivotally attached to the tissue platform120, and movement of the articulating jaw 110 is controlled by thehandle 190. In use, distal portion 105 is positioned such that when jaw110 is closed, tissue is held between an upper surface of thearticulating jaw 110 and a lower surface of the tissue platform 120. Thehandle 190 includes an articulating handle 191 and a stationary handle192. As the articulating handle 191 is moved away from and towards thestationary handle 192, the articulating jaw 110 is opened and thenclosed, respectively. The articulating handle 191 is attached to apush/pull rod 128, which moves along a groove 140A in the elongatedshaft 140. The rod 128 is attached to the articulating jaw 110 by apivot hinge assembly 165, described further below.

The suture grasper 130 is controlled by the trigger portion 150 and islocated on the tissue platform 120. Tissue platform 120 is the distalportion of shaft 140. Generally, the suture grasper 130 is designed toadvance forward and hold the suture. The trigger portion 150 includes atrigger mechanism 139 and a rod 138 (see FIG. 5B). The trigger mechanism139 is attached to the rod 138, which runs along the elongated shaft140, to control movement of the suture grasper 130.

Referring to FIG. 2, the articulating jaw 110 is attached at itsproximal end 119 to the tissue platform 120 by the pivot hinge assembly165. The pivot hinge assembly 165 includes two pins 166, 168 and a hingeconnector 167. The hinge connector 167 is part of the jaw 110 and isattached to the tissue platform 120 by the pin 166 such that thearticulating jaw 110 pivots about the pin 166 as the jaw 110articulates. The rod 128 is attached to the hinge connector 167 by thepin 168 such that forward and backward motion of the rod 128 causes thejaw 110 to pivot about the pin 166.

Referring to FIGS. 3A-3D, the push/pull rod 128 includes two tabs 128A,128B at its proximal end 129B. Rod 128 is an elongated square-shapedshaft. At its distal end 129A, rod 128 slopes away from its axis. Rod128 includes this slope in order to articulate the jaw 110 in relationto the action of the handle 190.

The rod 128 reciprocates within groove 140A in the instrument shaft 140as the articulating handle 191 is moved away from and then towards thestationary handle 192 to open and close the articulating jaw 110. Theinstrument shaft 140 also includes a limiting groove 140B in which tab128A is located. The axial movement of tab 128A in limiting groove 140Blimits movement of the rod 128 in the axial direction because axialmovement of tab 128A within the groove 140B is constrained by theproximal and distal sides of groove 140B. The articulating handle 191defines a handle slot 140C in which tab 128B is located providingcoupling between the rod 128 and the articulating handle 191 such thatas the handle 191 is moved, the rod 128 moves to actuate jaw 110.

Referring again to FIG. 2, the articulating jaw 110 includes a needle115. Generally, the needle 115 is sickle-shaped with a sharp point 113and is formed of hardened stainless steel or similar material. Theneedle 115 is formed integral to the articulating jaw 110 and extendsfrom the articulating jaw 110 toward the tissue platform 120. Needle 115includes a suture eyelet 111 disposed proximate to the tip 113 of theneedle 115. The needle 115 is sized such that when the articulating jaw110 is closed, the instrument can fit within a predetermined sizedcannula. Thus, the length of the needle 115 varies with different sizedcannulas.

Referring to FIGS. 4A and 4B, the tissue platform 120 has an U-shapedend 122C defining a passageway 122. The passageway 122 includes twosuture slots 121X, 121Y. The suture slots 121X, 121Y are positioned suchthat when the needle passes through passageway 122, the needle eyelet111 is aligned with the slots when the portion of the needle definingthe eyelet is within the passageway 122 to consistently place the suture101 that is threaded through the eyelet in the suture slots 121X, 121Y(see FIG. 4B). The suture rests in one of the suture slots 121X, 121Yafter the needle 115 has passed through the tissue. The slots 121X, 121Yare provided in each of the lengthwise sides 122A, 122B of thepassageway 122. Suture grasper 130 acts to move the suture away from theneedle 115 and holds the suture, for example, in slot 121X againstsurface 121A. Additionally, as the suture grasper 130 holds the sutureagainst the wall 121 a of the suture slot 121, the suture grasper 130also closes the opening in side 122A to capture the suture in the sutureslot 121X, as explained in more detail below.

Referring to FIGS. 1, 2, 5A, and 5B, the suture grasper 130 is locatedon the tissue platform 120 and is attached to rod 138. The suturegrasper 130 includes a suture capture device 132 in the form of an arm133 with an U-shaped tip 134. The suture grasper 130 is shown to oneside of the passageway 122 (the left side as viewed in FIG. 4A).However, the suture grasper 130 can be located on either side, e.g.,right or left, of the passageway 122. To minimize possible damage to thesuture, the suture is threaded through the eyelet 111 from the same sideon which the suture grasper 130 is located. Rod 138 is formed as a pairof parallel rods 138A, 138B that terminate at their proximal end at aspring plate 137A.

The suture grasper 130 is activated by the trigger portion 150 tocapture and hold the suture. The arm 133 of the suture capture device132 of the suture grasper 130 advances forward to hold the suture in theU-shaped tip 134 against the distal wall 121A of suture slot 121X (FIG.4A). The tissue platform 120 includes a grasper guide 170 under whichthe suture grasper 130 moves. The grasper guide 170, for example, isformed like a bridge such that as the suture grasper 130 moves forwardto hold the suture in suture slot 121X, the suture grasper 130 follows adirect path towards the distal end 105 of the instrument 100.

The tip 113 of the needle 115 on the articulating jaw 110 passes throughthe passageway 122 when the articulating jaw 110 is closed. Thepassageway 122 is slightly wider than the needle 115. The needle 115pivots about pin 166 along an arc 110 a (see FIG. 2). The needle 115 isshaped with an arch, which corresponds to the radius of the arc 110 a.Thus, when the needle 115 extends through the passageway 122, it archesover the suture grasper 130. The arch of the needle 115 limits possibletearing of the tissue as the needle passes through the tissue.

Referring to FIGS. 6A and 6B, the trigger portion 150 for moving thesuture grasper 130 includes the trigger mechanism 139, for example,shaped like a paddle, and the push/pull rod 138. The trigger mechanism139 rotates about an axis X. The trigger mechanism 139 is attached tothe push/pull rod 138 that ends in the U-shaped suture capture device132. The trigger portion 150 also includes a rigid pin 139A that followsa J-shaped groove 139B in the trigger mechanism 139 and a spring 137.

In its resting position, the suture grasper 130 is in an open, lockedposition with pin 139A located in the hook side 139B1 of the J-shapedgroove 139B, as shown in FIG. 6A. To create the forward movement of thesuture grasper 130 necessary to capture the suture, the triggermechanism 139 is rotated counter-clockwise (looking from the proximalend 190 down the shaft 140) to move the pin 139A from the hook side139B1 of the J-shaped groove 139B to the long side 139B2 of the J-groove139B, as shown in FIG. 6B. The movement of the pin 139A within thegroove 139B forces the push/pull rod 138 forward and the triggermechanism 139 proximally and then distally against the spring 137. Theforward movement of the suture grasper 130 is created as the spring 137moves forward against a spring plate 137A and back against a springbrake or spring plate 137B. To return the suture grasper 130 to itsresting position, the trigger mechanism 139A is rotated clockwise, e.g.,moved from the long side 139B2 of the J-shaped groove 139B back to thehook side 139B1 of the J-shaped groove 139B.

Referring to FIGS. 7A-7K, an operator uses the suture passing surgicalinstrument as follows. As shown in FIGS. 7A (top view) and 7B (sideview), an operator opens the articulating jaw 110, i.e., articulatingthe jaw 110 away from tissue platform 120, by moving handle 190 andloads suture into the suture eyelet 111 of the needle 115. As shown inFIG. 7C (top view), the operator moves handle 190 to close articulatingjaw 110 to hold the suture in the eyelet 111.

Then, as shown in FIG. 7D (side view), the operator passes theinstrument 100 down a cannula to the surgical site. As seen in FIG. 7E(side view), after placing the instrument 100 in the surgical site, theoperator moves handle 190 to open articulating jaw 110 to place theneedle 115 under the targeted tissue. As shown in FIGS. 7F (side view)and 7G (top view), the operator moves handle 190 to close articulatedjaw 110 to capture the targeted tissue between the jaw 110 and thetissue platform 120. The needle 115 on the articulating jaw 110 piercesthe tissue as the tissue is grasped between the tissue platform 120 andthe articulating jaw 110, carrying the suture through the tissue.

Next, as shown in FIGS. 7H (side view) and 7I (top view), the operatormoves trigger portion 150 to advance suture grasper 130 forward to holdsuture in the suture slot 121Y. As shown in FIGS. 7J (side view) and 7K(top view), the suture passed through the tissue is trapped on theproximal side of the tissue.

As shown in FIGS. 7L (side view) and 7M (top view), the operator moveshandle 190 to open articulating jaw 110 to release the tissue. As thejaw 110 is opened, the suture grasper 130 holds the suture against wall121A of suture slot 121X. As the operator begins to withdraw theinstrument 100 from the surgical site, the free end of the suture slidesout of eyelet 111 of needle 115. As shown in FIGS. 7N (side view) and 7O(top view), the free end 101A of the suture 101 (the end that wasthreaded through the eyelet 111) remains above the tissue platform 120.The other end of the suture is located in suture slot 121X and passesthrough the tissue. The operator moves handle 190 to close jaw 110 towithdraw instrument 100 through the cannula (not shown). The instrumentmay be rethreaded and reinserted through the cannula to the surgicalsite in order to pass suture multiple times. For instance, where mosttendon tissue are fibrous bundles, a repair that can be less prone totearing along the fibrous bundle structure can be possible when thesuture is secured perpendicular to the bundle cord with multiple passesof the suture. By passing suture through a different tissue bundle, thesuture/tendon interface can be improved.

Numerous alternative implementations or configurations of elements ofthe surgical instrument are possible. For instance, referring to FIGS.8A-8H, the suture eyelet disposed proximate to the tip of the needle canhave a variety of shapes and/or orientations. For example, FIG. 8A showsa rounded hole 211 as the suture eyelet, whereas FIG. 8B shows an ovalor oblong hole 311 as the suture eyelet. In an alternativeimplementation, there can be more than one hole 411, as shown in FIG.8C. Or, the suture eyelet can be a cutout in the side of the needleproximate to the tip. For example, FIGS. 8D and 8E show cutouts 511, 611that extend into the needle, toward the jaw 110. Alternatively, FIG. 8Fshows a cutout 711 disposed below the tip 713 of the needle 715 thatextends in both toward the tip 713 and toward the jaw 110. Or, theeyelet can be located on the rounded side of the needle, as shown inFIGS. 8G and 8H (e.g., cutouts 811, 911).

The various positions and shapes of the suture eyelets affect asurgeon's ability to load/unload suture, to penetrate tissue, and tominimize procedure length. For instance, the suture may be threadedthrough the rounded hole or closed eyelet type of suture eyelets, asshown, for example, in FIG. 9. While loading suture requires a bit moreskill, the closed eyelet type of suture needle penetrates tissue moreeasily and accurately. Additionally, for example, the double eyeletneedle shown in FIG. 8C may be used to pass two sutures simultaneouslyto form a mattress stitch with one pass and hence, reduce surgical time.With the cutout-type of suture eyelet, the suture is easier toload/unload, but tissue is more difficult to penetrate. Regardless oftype or orientation of suture eyelet, suture is loaded on the same sidethat the suture grasper is located.

The various embodiments discussed can include “free” suture or sutureattached to a soft tissue attachment device. As shown in FIG. 9, the“free” suture (suture not attached to an external device) is threadedthrough the suture eyelet 111 of the needle 115. The ability to use“free” suture with the suture passing surgical instrument provides asurgeon with the flexibility to use intricate weaving (suture) patternswithout the demand of visualizing each suture transfer. Alternatively,referring to FIG. 10, suture is attached to a soft tissue attachmentdevice, e.g., an anchor, prior to being threaded through the sutureeyelet 111.

Referring to FIG. 11, the surface 117 of the horizontal portion of thearticulating jaw 110 (the surface facing the tissue platform 120)includes serrations 124 (see also FIG. 2). The serrations 124, forexample, are “V” shaped and provide an increased surface area againstwhich to hold the tissue. The shape, number, and length of theserrations 124 can, for instance, vary. The serrations 124 can be, forexample, grooves, ribs, or ridges. Alternatively, the surface 117 issmooth, i.e., without serrations, as shown in FIGS. 8A-8H.

Referring to FIG. 12, the surface 127 of the tissue platform 120 (thesurface that faces the articulating jaw 110) includes serrations 123(see also FIG. 2). The serrations 123 of the tissue platform 120 are,for instance, V-shaped and provide a larger surface against which tohold the tissue after the needle 115 has penetrated the tissue. Theshape, number and length of the serrations 123 can vary. For example,the serrations 123 can be grooves, ribs, or ridges. A surgeon may wantto move the tissue after it has been grabbed to ensure that the tissuewill reach the attachment site. Or, if the detached tissue createsadhesions to other tissue surfaces, by pulling on the held tissue, thesurgeon can determine if it is necessary to release or cut thoseadhesions free.

Referring to FIGS. 13A-13C, an alternative implementation of the suturegrasper 230 includes a suture capture device 232 having two opposingjaws 233, 234 that, when advanced forward, flex outward to open aroundthe suture and then spring shut to enclose the suture between the twojaws 233, 234. The suture grasper 230 is moved forward by activation ofa push-pull rod 238 by an alternative implementation of the triggermechanism 339, a thumb push plate. The opposing jaws 233, 234 of thesuture grasper 230 initially contact an expansion pin 280, which causesthe jaws 233, 234 to open. The jaws 233, 234 of the suture capturedevice 232 include a plurality of grasping teeth 233 a, 234 a on theirfacing surfaces for holding the suture. The suture grasper 230 continuesto move forward until the expansion pin 280 enters the expansion pinrelease slot 285, at which point the opposing jaws 233, 234 of thegrasper 230 close on the suture.

A grasper guide 270 provides directional guidance for the suture grasper230 as the grasper moves forward along shaft 140 to capture the suturefrom the needle (not shown). The grasper guide 270 is a raisedstructure, e.g., a bridge, under which the suture grasper 230 moves. Inthis implementation of the guide 270, the expansion pin 280 is locatedbetween the grasper guide 270 and the tissue platform 120.

Other implementations or configurations of a suture capture deviceinclude, for example, a hook or pick that advances forward or movesbackward, pushes the suture away from the needle, and captures thesuture. For example, the hook may be a forward-moving hook 332, as shownin FIG. 14A; a backward-moving hook 432, 632, as shown in FIGS. 14B and14D; a forward-moving wedge 532, 732, as shown in FIGS. 14C and 14E; ora forward- or backward-moving hook 1032, as shown in FIG. 14H.Alternatively, as shown in FIGS. 14F and 14G, the cup-shape of thesuture capture device can have sides of different lengths (FIG. 14F) 832or a flat base of the cup (FIG. 14G) 932. As illustrated, for example,in FIGS. 14D-14H, the suture capture device alternatives are shownlocated on the left side of the tissue platform. However, the suturecapture device can be located on the right side of the tissue platform,for example, as in FIGS. 14A-14C, if the suture were loaded from adifferent direction.

Referring to FIGS. 15A and 15B, in an alternate implementation, thetrigger portion 250 includes a trigger mechanism 239, which is a hingedlever 239 attached to a push-pull rod 238 that ends in, e.g., one of thesuture capture devices of FIGS. 14A-14H. A locking mechanism 236, suchas a spring or ratchet-type lock is used to hold the suture capturedevice, e.g., suture pick or hook, in a retracted position and to retainthe suture capture device in a suture holding position. After the needle115 has passed through the tissue, the lever 239 is pulled towards thehandle 190 by the surgeon's finger. This action advances the push/pullrod 238 forward. The suture capture device then captures the suture fromthe needle and holds it in the suture slot. When the surgeon releaseslever 239, the locking mechanism acts to hold the suture capture devicein its suture holding position. To release the suture, the lever 239 isactuated again to advance the push/pull rod 238 and release the suture.

Referring to FIGS. 15C and 15D, in another alternative implementation,the trigger portion 350 includes a trigger mechanism 339 in the form ofa button 339, and a push rod 338. The thumb-operated button 339activates the push rod 338, which moves the suture grasper 130 in aforward direction to capture the suture with the suture capture device,e.g., suture capture device 232, after the articulating jaw 110 isclosed and the suture needle 115 has penetrated the tissue. The button339 is attached to the push rod 338 and the push rod 338 runs through asingle or a series of rings 335 that direct the suture grasper 130forward to grasp the suture. The articulating jaw 110 is then opened andremoved from the tissue.

A locking mechanism 336 for the suture grasper 130 is provided to securethe suture grasper 130 in position once the suture grasper 130 has beenactivated to hold the suture in the suture slot 121. The lockingmechanism can be a spring type mechanism that holds the suture capturedevice in a retracted position and retains the suture capture device ina suture holding position. Alternatively, as shown, the lockingmechanism includes a plurality of teeth 336A that mate with a latch336B, for example, within ring 335 (see FIG. 15D) or on the instrumenthandle 190 (not shown), in order to lock the suture grasper 130 inplace. To release, the locking mechanism 336, button 339 is pushed awayfrom the handle 190 to separate teeth 336A and latch 336B.

Referring to FIGS. 16A-16E, other implementations of the push/pull rodof the suture grasper include, for example, a dual split rodconfiguration 438 or a single rod configuration 538, 638, 738, 838. Inthe single rod configurations, the rod can have locking teeth 736, 836,as shown, for example, in FIGS. 16D and 16E. In each implementation, therod is attached at its proximal end to a thumb-plate, for example, thebutton 339 of FIG. 15B or an articulating lever, for example, lever 239of FIG. 15A.

Referring to FIGS. 17A-17J, an alternate implementation of a suturepassing surgical instrument 1700 includes an elongated shaft 1740 with adistal portion 1705 and a proximal portion 1745. At the proximal end ofthe elongated shaft, there is a handle 1790, a control arm 1712, and atrigger portion 1750. At the distal end, there is a set of jaws 1718,1720, a suture grasper 1730, and a moveable needle arm 1710.

The jaw 1718 is controlled by the handle 1790 and attached to theelongated shaft 1740 by a pivot hinge assembly 1765, as described abovein relation to articulating jaw 110.

The needle arm 1710 is attached to a push/pull rod 1713 and includes aneedle 1715 at its distal end. The push/pull rod 1713 runs along theelongated shaft 1740 and is actuated by a lever 1712 attached to thehandle 1790. The surgeon activates the lever 1712 with his finger tomove the needle arm 1715 forward and backward.

The suture grasper 1730 is controlled by the trigger portion 1750 anddisposed on jaw 1720, which is similar to the tissue platform 120described above. The trigger portion 1750 includes a trigger mechanism1739, e.g., a thumb-operated button, and a rod 1738. The thumb-operatedbutton 1739 is attached to the rod 1738, which runs along the elongatedshaft 1740 to control the movement of the suture grasper 1730, asdescribed above.

The trigger portion 1750 permits the surgeon to control when the surgeoncaptures the suture from the needle 1715, after the needle 1715 and thesuture have been passed through the tissue and are exposed above the jaw1720. As described above, the surgeon activates the button 1739 with histhumb to move the suture grasper 1730 forward to grasp the suture. Thetrigger portion may have similar alternatives and variations aspreviously described.

Referring to FIG. 17B, the push/pull rod 1728 includes two tabs 1728A,1728B at its proximal end and moves along a groove 1740A of theinstrument shaft 1740, as described above.

Referring to FIGS. 17C and 17D, the needle 1715 on the needle arm 1710is shaped like a tapered rectangle that ends in a sharp tip 1713. Theneedle 1715 is formed of nitinol, hardened stainless steel, or similarmaterials. The needle 1715 is formed integral to the needle arm 1710 orseparately and then rigidly attached (i.e., welded or mounted) to theneedle arm 1710.

The needle 1715 initially extends from the needle arm 1710, which isparallel to the pair of jaws 1718, 1720, and has a suture eyelet 1711disposed therein. Needle arm 1710 is attached to push/pull rod 1712 atpivot 1710A. The suture eyelet 1711 is disposed proximate to the tip1713 of the needle 1715. As described above, the suture eyelet 1711 can,for example, open to the front or side of the needle and have variousalternative shapes.

An operator moves the needle arm 1710 to articulate away from the set ofjaws 1718, 1720 in order for suture to be threaded onto the needle 1715.A “free” suture (not attached to anything) or suture attached to a softtissue attachment device, e.g., an anchor is threaded through the sutureeyelet 1711 of the needle 1715. The ability to use “free” suture withthe suture passing surgical instrument provides a surgeon with theflexibility to use intricate weaving (suture) patterns without thedemand of visualizing each suture transfer.

After suture is threaded through the needle 1715, an operator moveslever 1712 to return the needle arm 1710 parallel to the set of jaws1718, 1720. Movement of the push/pull rod 1712A distally causes theneedle arm 1710 to move distally until tip 1713 of needle 1715 contactsdeflector 1718A of jaw 1718. Contact with deflector 1718A by needle 1715causes needle 1715 to pivot towards jaw 1720 about pivot 1715A such thatneedle 1715 passes through passageway 1722B of jaw 1718 and passageway1722A of jaw 1720.

Referring to FIG. 17E, the surface 1728 of the jaw 1720 (the surfacethat faces the jaw 1718) and the surface 1717 of the horizontal portionof the jaw 1718 (the surface facing the jaw 1720) can be smooth and/orserrated. The serrations 1723, 1724, respectively, can vary in shape,number, and length, as described above.

Referring to FIGS. 17F and 17G, the set of jaws 1718, 1720 (shown inthese figures without grooves for clarity) includes passageways 1722A,1722B through which the needle 1715 of the needle arm 1710 passes. Eachpassageway 1722A, 1722B is slightly wider than the needle 1715.

The passageway 1722A of the jaw 1720 includes two suture slots orgrooves 1721X, 1721Y in which the suture rests after the needle 1715 haspassed through the tissue. In this implementation, the grooves 1721X,1721Y are provided in each lengthwise side 1722A1, 1722A2 of thepassageway 1722A. The suture capture device 1732 moves the suture awayfrom the needle 1715 and holds the suture for example in the suture slot1721X against surface 1721A as described above.

Jaw 1718 includes passageway 1722B, which is defined by a centralrectangular cutout. The Jaw 1718 can have similar grooves, as describedabove in relation to jaw 1720.

Jaw 1720 includes a U-shaped end 1720A defining passageway 1722A. Agrasper guide 1770, as described above, is located on the jaw 1720.

Referring to FIGS. 17A and 17H, suture grasper 1730 is disposed on jaw1720 and has similar alternatives as those described above.

Referring to FIGS. 18A-18E, an operator uses the suture passing surgicalinstrument 1700 of FIG. 17A as follows. From the position of instrument1700 as shown in FIG. 18A, the operator moves lever 1712 to movemoveable needle arm 1710 of the suture passing surgical instrument 1700away from the set of jaws 1718, 1720 to load suture through eyelet 1711.Then, the operator moves lever 1712 to return needle arm 1710 parallelto the set of jaws 1718, 1720, as shown in FIGS. 18B and 18D.

The operator places instrument 1700 in the surgical site through acannula (not shown) to the surgical site. The operator moves handle 1790to articulate jaw 1718 of the set of jaws 1718, 1720 such that the jaws1718, 1720 open and close to grasp tissue therebetween.

The operator moves lever 1712 moveable needle arm 1710 distally towardthe deflector 1718A of jaw 1718. Upon contacting deflector 1718A,moveable needle arm 1710 pivots about pivot 1715A toward jaw 1720 andpierces the tissue held by the jaws 1718, 1720 through passageway 1722A,1722B.

Next, the operator activates trigger portion 1750 to advance suturegrasper 1730 distally to hold the suture in suture slot 1721X. Theoperator moves lever 1712 to move needle arm 1710 back out of the set ofjaws 1718, 1720. The needle 1715 moves out of the tissue throughpassageway 1722A, 1722B. The operator then moves the lever 1712 toreturn the needle arm 1710 parallel to the set of jaws 1718, 1720, asshown in FIGS. 18C and 18E.

The operator moves handle 1790 to open the set of jaws 1718, 1720 torelease the tissue and then the operator moves handle 1790 to close thejaws 1718, 1720. The free end of the suture remains above the jaw 1720.The other end of the suture is located in the suture slot 1721X andthrough the tissue. The operator removes instrument 1700 from thesurgical site. The instrument may be rethreaded and reinserted throughthe cannula to the surgical site in order to pass suture multiple times.

A number of implementations have been described. Nevertheless, it willbe understood that various modifications may be made without departingfrom the spirit and scope. For example, the tissue platform may includeone suture slot or the needle may pass through tissue to either side ofthe articulating jaw or set of jaws. Alternatively, the passageway maybe offset to accommodate orientation of the needle or suture eyelet. Thesuture capture device may be or may include a latch or a cutout. Thetrigger portion may include a button or other mechanism to activatemovement of the suture grasper. The needle may be formed separately fromthe jaw and then rigidly attached, e.g., welded or mounted to the jaw.The eyelet of the needle may open to the front of the needle or to theinside of the needle.

Additionally, the instrument can be used in many surgical environments,including, for example, open, mini-open, and endoscopic, and withvisualization, limited visualization, or no visualization of the suturegrasper. Also, other devices for attaching tissue to bone or tissue totissue will work with the device and can be carried into the operativesite and attached or secured by the device. The type of material used,i.e., material construction, braided or monofilament or combinations ofconstruction and material type, synthetic, natural, permanent orreabsorbable, can vary, and a variety of material diameters arepossible. Loose or highly mobile tissue can be translocated as desiredby the surgeon. Also, the same suture strand can be passed throughtissue multiple times and in various directions. Accordingly, otherimplementations are within the scope of the following claims.

1-37. (canceled)
 38. Suturing instrumentation adapted for use with aneedle having a sharpened distal tip and attachable to a length ofsuture material, the instrumentation comprising: an elongated memberhaving a distal end terminating in a nonlinear portion; and a trocarconfigured for introduction into the elongated member, and the memberhaving a linear slot to receive a linear needle, the trocar including adistal end operative to push the needle through the nonlinear portion,such that when the distal end of the member is positioned proximate to atissue to be sutured and the needle is pushed by the distal end of thetrocar through the nonlinear portion, the needle is deformed, causingthe needle and suture material to enter into the tissue such that atleast a portion of a distal tip of the needle protrudes from the tissue.39. The suturing instrumentation as set forth in claim 38, wherein: theelongated member defines a primary axis; and the nonlinear portion isoff-axis.
 40. The suturing instrumentation as set forth in claim 38,wherein: the slot enabling the suture material to extend therefrom asthe needle is pushed through the nonlinear portion.
 41. The suturinginstrumentation as set forth in claim 38, wherein the needle comprises amalleable needle.
 42. The suturing instrumentation as set forth in claim38, wherein the needle comprises a deflectable needle.
 43. Suturinginstrumentation adapted for use with a needle having a sharpened distaltip and attachable to a length of suture material, the instrumentationcomprising: an elongated member having a distal end terminating in anonlinear portion; a trocar configured for introduction into theelongated member, the member having a linear slot to receive a linearneedle, the trocar including a distal end operative to push the needlethrough the nonlinear portion, such that when the distal end of themember is positioned proximate to a tissue to be sutured and the needleis pushed by the distal end of the trocar through the nonlinear portion,the needle is deformed, causing the needle and suture material to enterinto the tissue such that a least a portion of a distal tip of theneedle protrudes from the tissue; and a jaw coupled to the distal end ofthe member for holding tissue as the needle enters into the tissue andfor retaining the needle upon exiting the tissue.
 44. The suturinginstrumentation as set forth in claim 43, wherein the jaw includes anaperture, slot, or cavity to receive and retain the deformed needle uponexiting the tissue.
 45. The suturing instrumentation as set forth inclaim 43, wherein: the elongated member defines a primary axis; and thenonlinear portion is off-axis.
 46. The suturing instrumentation as setforth in claim 43, wherein: the slot-enabling the suture material toextend therefrom as the needle is pushed through the nonlinear portionby the trocar.
 47. The suturing instrumentation as set forth in claim43, further including a manually operated control enabling a user toopen and close the jaw.
 48. The suturing instrumentation as set forth inclaim 43, wherein the needle comprises a malleable needle.
 49. Thesuturing instrumentation as set forth in claim 43, wherein the needlecomprises a deflectable needle.
 50. Suturing instrumentation adapted foruse with a needle having a sharpened distal tip and attachable to alength of suture material, the instrumentation comprising: a hand-heldtool having proximal and distal ends; an elongated member extending thelength of the tool and terminating distally in a nonlinear portion; themember having a linear slot to receive a linear needle, a trocar havinga distal end disposed within the elongated member and an exposedproximal end, such that when the distal end of the member is positionedproximate to a tissue to be sutured and the exposed proximal end of thetrocar is pushed, the needle inelastically deforms as it passes throughthe nonlinear portion, causing the needle and suture material to enterinto the tissue such that at least a portion of a distal tip of theneedle protrudes from the tissue; a pivoting jaw at the distal end ofthe member for holding tissue as the needle enters into the tissue andfor retaining the needle upon exiting the tissue; and a manuallyoperated control at the proximal end of the hand-held tool enabling auser to open and close the jaw.
 51. The suturing instrumentation as setforth in claim 50, wherein: the slot-enabling the suture material toextend therefrom as the needle is pushed through the nonlinear portion.52. The suturing instrumentation as set forth in claim 50, wherein thejaw includes an aperture, slot, or cavity to receive and retain thedeformed needle upon exiting the tissue.
 53. The suturinginstrumentation as set forth in claim 50, wherein: the elongated memberdefines a primary axis; and the nonlinear portion is off-axis.
 54. Thesuturing instrumentation as set forth in claim 50, wherein the needlecomprises a malleable needle.
 55. The suturing instrumentation as setforth in claim 50, wherein the needle comprises a deflectable needle.56. Suturing instrumentation, comprising: a linear needle having asharpened distal tip and attachable to a length of suture material; anelongated member having a distal end terminating in a nonlinear portion;and a trocar configured for introduction into the elongated member, thetrocar including a distal end operative to push the needle through thenonlinear portion, such that when the distal end of the member ispositioned proximate to a tissue to be sutured and the needle is pushedby the distal end of the trocar through the nonlinear portion, theneedle is deformed by the nonlinear portion, causing the needle andsuture material to enter into the tissue such that at least a portion ofa distal tip of the needle protrudes from the tissue.
 57. The suturinginstrumentation as set forth in claim 56, wherein: the elongated memberdefines a primary axis; and the nonlinear portion is off-axis.
 58. Thesuturing instrumentation as set forth in claim 56, wherein: the distalend of the member includes an elongated slot to receive the needleenabling the suture material to extend therefrom as the needle is pushedthrough the nonlinear portion.
 59. The suturing instrumentation as setforth in claim 56, further including a pivoting jaw at the distal end ofthe member for holding tissue as the needle enters into the tissue andfor retaining the needle upon exiting the tissue.
 60. The suturinginstrumentation as set forth in claim 59, wherein the jaw includes anaperture, slot, or cavity to receive and retain the deformed needle. 61.The suturing instrumentation as set forth in claim 59, further includinga manually operated control enabling a user to open and close the jaw.62. The suturing instrumentation as set forth in claim 56, wherein theneedle and elongated member have at least one flat side to resistrotation of the needle as it passes through the non-linear portion. 63.The suturing instrumentation as set forth in claim 56, wherein theneedle and elongated member have opposing flat sides to resist rotationof the needle as it passes through the non-linear portion.
 64. Thesuturing instrumentation as set forth in claim 56, further comprising ajaw at the distal end of the member, the jaw including an aperture,slot, or cavity to receive and retain the needle.
 65. The suturinginstrumentation as set forth in claim 56, wherein the needle comprises amalleable needle.
 66. The suturing instrumentation as set forth in claim56, wherein the needle comprises a deflectable needle.
 67. A sutureneedle adapted for use with a substantially rigid cannula defining anaxis and having an off-axis distal end, the needle comprising: a lengthof material attachable to a suture on a lateral surface of the needle ata distance from a proximal end of the needle and a sharpened distal tip;and the needle being formed such that when the needle is pushed throughthe cannula, it inelastically deforms in accordance with the off-axisdistal end.
 68. The suture needle as set forth in claim 67, wherein thelength of material includes one or more flat sides to resist rotationparticularly as the needle passes through the off-axis portion of thecannula.
 69. The suture needle as set forth in claim 68, wherein thelength of material includes opposing flat sides.
 70. The suture needleas set forth in claim 67, wherein the needle comprises a malleableneedle.
 71. The suture needle as set forth in claim 67, wherein theneedle comprises a deflectable needle.
 72. Suturing instrumentation forsuturing tissue comprising: a needle portion having a sharpened distaltip and constructed and arranged to deliver a length of suture materialto the tissue; a handheld instrument having a passageway and having adistal end terminating in a nonlinear portion; and a force-supplyingstructure configured for applying a force to the needle portion, whereinthe force-supplying structure includes a distal end capable of pushingthe needle portion through the nonlinear portion, such that when thedistal end of the handheld instrument is positioned proximate to thetissue to be sutured and the needle portion is pushed by the distal endof the force-supplying structure through the nonlinear portion, theneedle portion is deformed, thereby causing the needle portion todeliver the suture material to the tissue.
 73. The suturinginstrumentation of claim 72, wherein the handheld instrument includes aproximal insertion opening to receive the distal end of theforce-supplying structure.
 74. The suturing instrumentation of claim 72,wherein the distal end of the handheld instrument includes an elongatedslot to receive the needle portion enabling the suture material toextend therefrom as the needle portion is pushed through the nonlinearportion.
 75. The suturing instrumentation of claim 72, wherein theneedle portion has a degree of spring back of from 0 to about 100percent.
 76. The suturing instrumentation of claim 72, wherein theneedle portion comprises a Nitinol needle.
 77. The suturinginstrumentation of claim 76, wherein the Nitinol needle is substantiallylinear in shape, further wherein the Nitinol needle is forcibly deformedthrough the nonlinear portion of the handheld instrument.
 78. Thesuturing instrumentation of claim 72, wherein the needle comprises amalleable needle.
 79. The suturing instrumentation of claim 72, whereinthe needle comprises a deflectable needle.
 80. Suturing instrumentationfor suturing tissue comprising: a needle portion having a sharpeneddistal tip and constructed and arranged to deliver a length of suturematerial to the tissue; a handheld instrument having a passageway andhaving a distal end terminating in a nonlinear portion; and a forcesupplying structure configured for applying a force to the needleportion, wherein the force supplying structure includes a distal endcapable of pushing the needle portion through the nonlinear portion,such that when the distal end of the handheld instrument is positionedproximate to the tissue to be sutured and the needle portion is pushedby the distal end of the force supplying structure through the nonlinearportion, the needle portion is deformed, thereby causing the needleportion to deliver the suture material to the tissue; and a jaw at thedistal end of the handheld instrument for holding tissue as the needleportion and suture material enters into the tissue.
 81. The suturinginstrumentation of claim 80, wherein the jaw includes an aperture, slot,or cavity to receive the deformed needle portion.
 82. The suturinginstrumentation of claim 80, wherein the handheld instrument includes aproximal insertion opening to receive the distal end of theforce-supplying structure.
 83. The suturing instrumentation of claim 80,wherein the distal end of the handheld instrument includes an elongatedslot to receive the needle portion enabling the suture material toextend therefrom as the needle portion is pushed through the nonlinearportion.
 84. The suturing instrumentation of claim 80, wherein theneedle portion comprises a Nitinol needle.
 85. The suturinginstrumentation of claim 80, further including a manually operatedcontrol enabling a user to open and close the jaw.
 86. The suturinginstrumentation of claim 80, wherein the jaw pivots.
 87. The suturinginstrumentation of claim 80, wherein the needle comprises a malleableneedle.
 88. The suturing instrumentation of claim 80, wherein the needlecomprises a deflectable needle.
 89. A suture needle adapted for use witha handheld instrument defining an axis and having an off-axis distalend, the needle comprising: a length of material having a sharpeneddistal tip and constructed and arranged to deliver a length of suturematerial; and the needle being formed such that when the needle ispushed through the handheld instrument, it deforms in accordance withthe off-axis distal end.
 90. The suture needle of claim 89, wherein thelength of material includes one or more flat sides to resist rotation asthe needle passes through the off-axis portion of the handheldinstrument.
 91. The suture needle of claim 90, wherein the length ofmaterial includes opposing flat sides.
 92. The suture needle of claim89, wherein the needle comprises a malleable needle.
 93. The sutureneedle of claim 89, wherein the needle comprises a deflectable needle.94. A suturing system comprising: a needle portion having a sharpeneddistal tip and constructed and arranged to deliver a length of suturematerial; a handheld instrument having a passageway and having a distalend terminating in a nonlinear portion; and a push member configured formovement in the passageway of the handheld instrument, the push memberbeing operative to push the needle portion through the nonlinearportion, such that when the distal end of the handheld instrument ispositioned proximate to a tissue to be sutured and the needle portion ispushed by the push member through the nonlinear portion, the needleportion is deformed and enters into the tissue and delivers the suturematerial to the tissue being sutured.
 95. The suturing system of claim94, wherein the needle portion is substantially straight when in atleast a portion of the passageway, curved when in the distal end, andcurved upon exiting the distal end of the handheld instrument.
 96. Thesuturing system of claim 94, wherein the needle portion is substantiallystraight when in at least a portion of the passageway, deformed when inthe distal end, and substantially straight upon exiting the distal endof the handheld instrument.
 97. The suturing system of claim 94, whereinthe needle portion comprises a Nitinol needle.
 98. The suturing systemof claim 94, wherein the needle comprises a malleable needle.
 99. Thesuturing system of claim 94, wherein the needle comprises a deflectableneedle.
 100. A method for suturing, comprising the steps of: providing aneedle portion having a sharpened distal tip; positioning the needleportion in a passageway of a handheld instrument; providing a suturematerial to be delivered by the needle portion; and using a push memberto push the needle portion in the handheld instrument, the needleportion upon exiting the handheld instrument penetrating the tissuebeing sutured and delivering the suture material to the tissue beingsutured.
 101. The method of claim 100, wherein the handheld instrumenthas a distal end terminating in a nonlinear portion, and the needleportion is deformed as it traverses the nonlinear portion.
 102. Themethod of claim 100, wherein the needle portion comprises a Nitinolneedle.
 103. The method of claim 100, wherein the needle portioncomprises a malleable needle.
 104. The method of claim 100, wherein theneedle portion comprises a deflectable needle.
 105. A suture passinginstrument, comprising: an elongated member having a proximal end and adistal end, the member comprising at least one axial throughbore forreceiving a tissue penetrating element therein; a tip and a jaw providedat the distal end of the member, a first of the tip and jaw beingintegral with the member and the second of the tip and jaw beingpivotable with respect to the first of the tip and the jaw, one of thetip and jaw including at least one axial bore in communication with theaxial throughbore of the tubular member for receiving the tissuepenetrating element, and the other of the tip and jaw comprising adistal transverse opening aligned with the axial bore of the one of thetip and jaw for receiving the tissue penetrating element therein. 106.The suture passing instrument of claim 105, wherein the tip furthercomprises a slot for receiving suture.
 107. The suture passinginstrument of claim 106, wherein the slot is orthogonal to the at leastone axial bore.
 108. The suture passing instrument of claim 105, whereinthe member comprises another axial throughbore for receiving anactuator.
 109. The suture passing instrument of claim 105, wherein thedistal transverse opening is an open slot.
 110. The suture passinginstrument of claim 105, further comprising a pusher provided at theproximal end of the member and comprising a pusher axial bore incommunication with both the axial throughbore of the member and theaxial bore.
 111. The suture passing instrument of claim 105, wherein thejaw further comprises a plurality of teeth for gripping tissue.
 112. Thesuture passing instrument of claim 105, wherein the tissue penetratingelement is superelastic.
 113. The suture passing instrument of claim112, wherein the tissue penetrating element comprises nitinol.
 114. Amethod of suturing tissue, comprising the steps of: positioning a suturepassing instrument in the proximity of a tissue to be sutured, thesuture passing instrument being formed of an elongated member having aproximal end and a distal end, the member comprising at least one axialthroughbore for receiving a shape-memory tissue penetrating elementtherein; a tip and a jaw provided at the distal end of the member, afirst of the tip and jaw being integral with the member and a second ofthe tip and jaw being pivotable with respect to the first of the tip andjaw, one of the tip and jaw including at least one axial bore incommunication with the axial throughbore of the member; and the other ofthe tip and jaw being provided with a distal transverse opening alignedwith the axial bore of the one of the tip and jaw for receiving thetissue penetrating element therein; placing a strand of suture within aslot of the one of the tip and jaw, the slot being substantiallyorthogonal to and intersecting the axial bore of the one of the tip andjaw; moving the tissue penetrating element through the axial throughboreof the one of the tip and jaw to engage the strand of suture andpenetrate the tissue to be sutured with the tissue penetrating elementand the suture.
 115. The method of claim 114, further comprising thestep of retrieving the tissue penetrating element from at least one ofthe tip and jaw subsequent to the step of penetrating the tissue to besutured.
 116. The method of claim 115, further comprising the steps offorming a suture loop in the tissue to be sutured and pulling the suturethrough the tissue to be sutured.
 117. The method of claim 114, whereinthe step of advancing the tissue penetrating element through the axialthroughbore of the member and the one of the tip and jaw furthercomprises actuating a pusher provided at the proximal end of the member.118. The method of claim 114, wherein the tissue penetrating elementcomprises nitinol.
 119. The method of claim 114, wherein the distaltransverse opening has an open slot configuration.